by Dr Michael Farrell

Methadone prescribing remains a highly controversial and contentious activity. Despite reasonable evidence of its benefits there remains a deep suspicion and antipathy among drug users, drug services, professionals and the broader community to methadone and other substitute prescribing.

The generality of this negative attitude makes the long-term viability of such services uncertain and very vulnerable to hostile criticism. Much of the discussion and criticism are based on belief systems, be these treatment, religious or philosophical. Some such criticism may not be amenable to change in the light of empirical evidence on the effectiveness of substitute treatment.

This book provides a comprehensive background on the history, research, pharmacology and legal aspects of methadone prescribing. It focuses on this single substance in practical aspects of assessment, treatment aims, dosages and detoxification and should be a valuable reference for workers in the field.

In looking at substitute prescribing there are three dimensions of consideration:

1. The type of drug prescribed and its properties, the administration system which includes whether the drug is taken on or off site and whether it is consumed with or without supervision

2. What other sorts of rules and contingencies are associated with the administration of the drug, and

3. The types of psycho-social interventions associated with the first two, including vocational training, education, counselling, psychotherapy, physical health care, and welfare and legal rights information.

It is clear that methadone prescribing can be well done or badly done, and badly delivered methadone treatment may be substantially worse than badly delivered treatments that do not involve prescribing. The principle of 'do no harm' needs to be carefully observed in the context of substitute prescribing.

Andrew Preston has performed a monumental and scholarly task in pulling all this information together.

The section on the history of methadone should put some well worn myths to rest: in particular the text points out that the name 'Dolophine' - which was reputed to be derived from Adolf Hitler - was not in fact created as a trade name until after the war, by the Eli-Lilly pharmaceutical company, and was probably derived from the French words 'dolor' (pain) and 'fin' (end).

Finally as the area of substitute prescribing becomes more textured, issues such as the balance between short-term maintenance and long-term maintenance and oral and injectable prescribing is well argued and will provide the basis for further discussion on these subjects.

I am certain that this text will be a valuable guide for those embarking on the challenging but rewarding task of working with drug users to help them achieve greater control over their lives.